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Endocrine > DM > Flashcards

DM Flashcards

1
Q

What is DM

A

Chronic condition characterised by abnormal high BG

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2
Q

Why is managing DM important

A

Prevent microvascular - eye / kidney / nerve complications

Prevent macrovascular - IHD / stroke complications

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3
Q

What are the types of DM

A 
Type 1
Type 2 
Gestational
MODY 
Other
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4
Q

What causes type 1

A

Autoimmune attack on beta cells so destroyed
Results in absolute deficiency of insulin
Genetic + trigger
Associated with other autoimmune conditions

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5
Q

What Ab associated

A

GAD Ab

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6
Q

How and when does type 1 present

A

Childhood
Symptomatic or acutely unwell e.g. DKA
Prone to DKA and weight loss

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7
Q

What does type 1 require

A

Daily insulin or will be fatal
SC or IV
Can’t take oral as will be broken down by gut

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8
Q

What causes type II

A

Deficiency in insulin due to express adipose insensitivity and pancreas not able to produce enough
B cells normal and may even have hyper insulin

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9
Q

What causes insensitivity

A

Obesity = increased Fa decreasing insulin sensitivity

If pancreas can’t secrete enough to meet demand will become diabetic

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10
Q

What is the genetic component of type II

A

Whether pancreas can secrete higher levels

NOT adipose genes or HLA

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11
Q

What is associated with type II

A 
Obesity - central adiposity (reversible) 
FH
Age
Ethnicity - south Asian / black 
Gestational
Inactivity
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12
Q

What is MODY

A

AD genetic disorder affecting B cells and production

Glucokinase / transcription factor mutation

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13
Q

How does MODY tend to present

A

Younger patient <25
Symptoms similar to type II
DKA not a feature
FH of early onset

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14
Q

What drugs are MODY patient sensitive to

A

Sulphonylurea - gligliazide

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15
Q

What are other causes of DM

A 
Chronic pancreatitis
Haemochromotosis 
CF
Drugs - glucocorticoid
Cushing's
Acromegaly
Phaeochromocytoma
Hyperthyroid 
Pregnancy
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16
Q

How does type 1 present

A

Polyuria - water dragged out with glucose
Polydipsia
Weight loss
Fatigue
Blurred vision - glucose builds up in from of lens
Thrush / recurrent infection - oral candidiasis
Slow wound healing
DKA

17
Q

How does type II present

A 
Incidental on bloods
Same symptoms as type I
Can present with complications
Often overweight
No ketones
18
Q

What is needed to diagnose DM

A 
Symptoms + 1+ or 2+ of 
Blood glucose fasted >7
Random BG >11.1
OGTT >11.1
HbA1c >48
19
Q

What is OGTT

A

Take 75g CHO

Take BG before and 2 hours after

20
Q

What is HbA1c

A

Tool used to measure long term control
Shows average BG over 3 month period
Dependent on RBC lifespan and average BG

21
Q

How often should you check

A

Every 3-6 months until stable then 6 monthly

22
Q

What causes reduced levels as reduced life span of RBC

A

Sickle cell
G6PD
Hereditary spherocytosis
Haemolytic anaemia

23
Q

What causes higher levels as increased RBC lifespan

A

Vit B12 / folic deficiency
Iron deficiency
Splenectomy

24
Q

When can HbA1c not be used as diagnostic tool

A 
Type 1 
Children
Pregnancy
If short duration of Sx
Acutely ill 
CKD 
HIV 
People on meds that may cause hyperglycaemia - steroid / anti-psychotic 
Acute pancreatic damage 
Anaemia's / haemoglobinopathy
25
Q

What is pre-diabetic

A

Impaired glucose fasting

Impaired glucose tolerance

26
Q

What causes

A

IGF due to hepatic resistance

IGT due to muscle resistance

27
Q

What happens if discovered to be pre-diabetic

A

Surveillance as high risk of type II
Lifestyle measure
Yearly follow up

28
Q

What are blood test levels of pre-diabetic range

A

HbA1c 6.1-7
Fasting BG 6.1-7
OGTT >7.8 but <11.1

29
Q

How do you treat DM

A

Normalise BG with lifestyle or drugs
Monitor and Rx complications - annual foot, eye and kidney screen
Modify CVS RF - cholesterol / BP

30
Q

When investigating DM what other tests can be done

A 
FBC 
U+E - osmotic Sx / dehydration
Bicarb - if high suggests acidosis
Liver function - DM 2 to NAFLD
Test for coeliac in all newly Dx type 1 
TFT - common in type II
GAD Ab
31
Q

How do you monitor DM

A

HbA1c every 3-6 months

Capillary blood glucose

32
Q

What is an insulinoma and how does it occur

A

Benign pancreatic islet tumour
Sporadic
Associated with MEN 1

33
Q

How does it present

A

Fasting hypo with Whipples triad

34
Q

What is Whipples

A

Symptoms associated with fasting or exercise
Recorded hypo with Sx
Symptoms relived with glucose

35
Q

How do you screen

A

Hypoglycaemia with increased plasma insulin

36
Q

What suppressive test can be done

A

Give IV insulin and measure C-peptide

Normally exogenous insulin will suppress C-peptide but this does not occur

37
Q

How do you image

A

CT / MRI with pancreatic USS

38
Q

How do you Rx

A

Excision

39
Q

How do you differentiate from type 1 and type 2

A

C-PEPTIDE
Low in type 1 as no insulin produced to brea down
Normal or high in type 2

Endocrine (17 decks)

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